Talking dual eligibles, MedPAC with a Harvard long-term care guru

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Marty Stempniak, Staff Writer
Marty Stempniak, Staff Writer

We all have something that we'll admit to getting a little geeky about.

Maybe it's the latest “Star Wars” movie, or umpteenth installment in the ongoing Marvel universe. For me, I will freely admit to frequently wasting three hours of my life watching a Chicago Cubs game, followed by re-watching the highlights, and then reading 17 articles, as if I hadn't spent enough precious moments with this confounding baseball team. My inner geek, too, goes gaga over horror movies, and I am slightly more embarrassed to mention that I recently saw one flick at 11 p.m. the day it was released because I couldn't wait until tomorrow, and I am about to buy a ticket to my seventh or eighth 24-hour horror movie marathon, which is coming up in September.

All of this is a long-winded way of working up to David Grabowski, who was the subject of our June back-page profile in McKnight's Long-Term Care News. While you or I might get geeky about insignificant things such as baseball box scores or cheesey '80s cult classics, the Harvard healthcare policy professor's admitted geekdom is much deeper, and actually has an impact on the well-being of our country and its seniors.

I recently spent a few minutes with Grabowski, who is also a member of the Medicare Payment Advisory Commission, which made the news earlier this week for its objections to skilled nursing getting a pay raise. He talked openly about his obsessions.

“As a health policy/post-acute care/long-term care geek, there isn't anything better than going to a MedPAC meeting and spending a day and a half kind of getting into the weeds on these issues,” he told McKnight's “I was, from the get go, just really intrigued, interested and still completely immersed in this area,” he added later. “It was everything that I enjoy about healthcare policy, only more so — the role of government, the role of families, the ability to substitute services across different settings, the important role of individuals in terms of labor.”

What made it into our June story was a lot of personality-type details, so I wanted to share a little more of the nitty-gritty policy tidbits now.

Grabowski has written numerous research papers that are relevant to the long-term care field. His CV alone is 33 pages! I was curious what might be on the horizon in his research interests. The wave of mergers, for one, is something that he'd like to delve into more deeply.

“I've been really fascinated by this consolidation we're seeing right now in healthcare,” he told me.  “This is not a new trend. It's been happening with private equity investment in long-term care. But, what are the implications that's had for the delivery of services, the quality of care, but then more recently, the fragmentation, as ownership is separated from operations in this industry? The most recent wave of deals has involved vertical integration, with nursing home and post-acute care providers being acquired by hospital systems, and oftentimes encompassing hospice. So I'm really interested in what's driving this, and then what are the potential consequences for patients?”

Grabowski is also driven to better understand what makes the most sense for patients in the post-acute world, given the myriad of settings from which patients and their caregivers must choose.

“I remain fascinated with post-acute care,” he told me. “We have four very different settings, and patients who look very similar in a lot of ways, being discharged to all of these different settings. I don't think we have a strong basis right now for determining which patient benefits from which setting and which amount of care and at which time. In some ways we are flying blind, and so how do we determine whether an individual with a moderate stroke is better off in home health or skilled nursing, for example?”

A third and final area of interest that has brought about particular interest is the issue of dual eligibles, who are able to collect benefits from both Medicare and Medicaid. Grabowski feels those individuals, for too long, have gotten the short shrift, and deserve more attention in the research realm.

“I think one of the areas in health policy that's going to be front and center is this issue of how we provide better, more integrated care for dually eligible beneficiaries,” he said. “Historically, we've really dropped the ball with this population. They're the frailest beneficiaries in our healthcare system, they're the most medically complex, and the also get the worst quality. And, I'm really passionate about how we come up with better care models for this population.”

I'll leave those big questions to the variety of geeks like Grabowski who are using their nerdisms to make the world a little better place. Meanwhile, I've got to get the heck home. Cubs game starts soon, and I'm worried about the Massacre Marathon selling out this year.

Follow Staff Writer Marty Stempniak @mstempniak.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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